Non-operative ACL Tear Treatment

Conservative management of ACL tears is an option that many patients and physicians choose when it come to a torn ACL. The ACL, or Anterior Cruciate Ligament, runs from the front of the tibia (lower leg bone) to the back of the femur (Upper leg bone). This ligament prevents the knee from translating in an anterior (forward) position. When this ligament is torn, it brings about two basic choices: conservative rehab or surgical repair with rehab. Today I would like to explore the options and potential problems with conservative, non-operative treatment.

Non-operative treatment means for ACL deficient patients is widely discussed. The goals of rehab for a person with an ACL tear are to promote co-contraction strength of the lower leg muscles, along with balance and proprioception training. Bracing and other support may be necessary for athletic events in general if the surgery is not explored.

Chronic ACL deficiency will remain, and may speed up the symptoms of arthritis, laxity in the joint and potential meniscal damage. Also proprioception and increased movement will be present. Anyone with a chronic ACL instability will have a history of buckling knees, effusion and pain symptoms. These are important factors to keep in mind when considering surgery vs. rehab.

Treatment will initially consist of RICE-Rest, Ice, Compression and Elevation to alleviate the acute symptoms. Further treatment will consist of focusing on contraction of the quadriceps and hamstrings muscles together to help stabilize the joint. Electrical stimulation may be used to help improve muscle firing and help the patient gain control of the contraction. Closed chain, or weight bearing exercises are suggested for a better improvement in joint proprioception. These could include balance board, single leg balance, lunges, squats or other similar exercises. Bracing is another component of treatment that may be used in some patients to help further boost confidence in the stability for the patient.

The potential problems with this type of rehab are that the process may just not be enough. Some patients, despite the focus on co-contraction strengthening and proprioception exercises, are unable to attain a tolerable amount of stability. These patients will report the same buckling, unstable symptoms at the knee along with swelling and possible pain. Non-conservative treatment may be necessary at this point, including a possible ACL repair based on the discussion by the doctor and patient.

I hope this information will help you in your decision following a traumatic injury, such as this tends to be. Strengthening and a focus on everyday activities will help you determine your rehabilitation focus.